Tiered Network/Blue Options is a family of health plans that engages members with their health and coverage every time they get care through tiered benefits.
To improve the quality and affordability of health care, we will be implementing several enhancements to our standard plan designs. Learn about the plan changes designed to make health care more affordable.
With the plan, Massachusetts primary care provider (PCPs) and acute-care hospitals are placed into one of three benefits tiers based on how they scored on cost and nationally accepted quality benchmarks.
The tiered network drives value throughout the health plan because each time members seek care from a PCP or hospital, their cost sharing is based on the tier status of the provider they see.
This helps encourage members to consider the cost and quality of their PCP or hospital each time they get care and rewards them for choosing providers on the Enhanced or Standard Benefits Tiers.
Other benefits of the Blue Options family of plans:
- Lower premium costs
- The comprehensive coverage and easy to understand benefits of HMO Blue® and/or PPO Blue® plans
- Access to office visits, prescriptions, emergency room visits, and mental health care for a copayment, similar to other HMO Blue and/or PPO Blue
Within Massachusetts, each time members seek care from a PCP or hospital, their cost sharing is based on which of the three tiers* the provider is assigned to. This helps encourage members to consider the cost and quality of their PCP or hospital each time they get care and rewards them for choosing providers in enhanced or standard benefits tiers.
- Enhanced Benefits Tier—Includes Massachusetts hospitals and PCPs that meet the standards for quality and low cost relative to our benchmark.
- Standard Benefits Tier—Includes Massachusetts hospitals and PCPs that meet the standards for quality and are moderate cost relative to our benchmark and hospitals that do not meet the standards for quality but are low or moderate cost relative to our benchmark. Also includes providers without sufficient data for measurement on one or both benchmarks. To ensure members have provider access in certain geographic areas, the Standard Benefits Tier includes some providers whose scores would otherwise put them in the Basic Benefits Tier.
- Basic Benefits Tier—Includes Massachusetts hospitals that are high cost relative to our benchmark and PCPs that do not meet the standards for quality and/or are high cost relative to our benchmark.
* Note: PCPs were measured based on their HMO patients as part of their provider group, and hospitals were measured based on their individual facility performance. Provider groups can be composed of an individual provider, or a number of providers who practice together. Tier placement is based on cost and quality benchmarks where measurable data is available. Providers without sufficient data for cost and quality are placed in the Standard Benefits Tier. PCPs that do not meet benchmarks for one or both of the domains and hospitals that do not meet benchmarks for cost or that use nonstandard reimbursement are placed in the Basic Benefits Tier.
You have access to the tools and information that can make selling the Blue Options plans easy.
Blue Options Brochure — Introduces the value of the Blue Options plans to your clients.
Blue Options Fact Sheet — A quick overview explaining the benefits of Blue Options plans.
Tiered Services Cost Comparison Fact Sheet — See how the costs of services on different tiers stack up and how the Blue Options plans help drive members to high-value providers
Blue Options Educational Resources — Our Learn, Plan, Save approach helps members find lower-cost, high-quality hospitals, free standing labs and imaging centers.
Your clients have access to a wide range of support tools to make educating and engaging their employees easy.
You can also access the tools by following the links below:
- Member Education Web site — our specially designed web site (myplans.bluecrossma.com/medical-insurance/blue-options) makes it easy for new and current members to use their plan efficiently.
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For more information on the Blue Options plans, contact your account executive or broker.
* National tiering is available to self-insured employers only.
This web site gives general information about our tiered network plan designs. There are currently three tiered provider networks called HMO Blue Options v.5, HMO Blue New England Options v.5, and Preferred Blue PPO Options v.5. In our tiered plans, members pay different levels of cost share (copayments, coinsurance, and/or deductibles) depending on the benefits tier of the provider furnishing the services. A provider's benefits tier may change. Overall changes to the benefits tiers of providers will happen no more than once each calendar year. For help in finding the benefits tier of a provider, visit the online provider search tool and search for the appropriate network.